Insomnia in the MICU, or: Welcome to 2006!

I've had a strangely hyperactive day in the MICU today. I'm on call New Year's Even--thus far it's been it's usual frenetic pace, but fortunately a group of us (residents) gathered by the windows overlooking the Philadelphia skyline to watch the fireworks go off in the distance at midnight. Somebody had brought in some apple cider bubbly and as we toasted each other with styrofoam cups I have to admit the mood was quite festive and it is a New Year's Eve I shall always remember!

The damage thus far: one asthma/cocaine binge who had to be intubated (placed on the breathing machine) and another gentleman with massive liver failure that we haven't totally figured out yet. Who knows...the night still may hold another surprise for us!

One thing I just cannot understand--although I am already starting to show the signs of chronic fatigue, I am uanble to get a restful sleep in the MICU call room...the atmosphere is just too intense and I have racing thoughts about the many difficult patients under my care...which is why I sit here typing like a fool at 2:15 in the morning during a rare moment of peace...

May 2006 be a year to remember for us all!

MICU Beatdown

Question: How are Nate Hellman and Rodney King similar?
Answer: They both suffered a humiliating beat-down.

About an hour or so after posting my message giving the impression that it was a quiet night in the MICU, there was a major influx of sick patients. I got about 30 minutes of sleep for the night and am still recovering after today, my "good day" (meaning that I worked the typical 7am-6pm shift). Tomorrow it's back on call, and I'm feeling more and more like the only two places I get to see are my apartment and the two floors of the hospital on which the MICU is located.

Live! From the MICU!

It's Wednesday night!

First day in the MICU, on-call not quite 1/2 way through the shift, and believe it or not I actually have a bit of down time right now...although as always, a busy night is only one code call away...

For now me & my star intern Zack have the MICU running smoothly. To be truthful, I should say that the MICU nurses have the MICU running smoothly, since they do the lion's share of the actual work on the patients. We were greeted with a 7am admission (hypotension, acute-on-chronic renal failure) and in the afternoon a transfer from the floor (pneumonia plus gastrointestinal bleed)--both of which are sick but thus far not completely tanking.

Time to Pay the Piper

My days of lollygaggin’ around and carefree living are gone…my MICU rotation is now beginning.

The MICU stands for the Medical Intensive Care Unit. It is a land of endless work, near-hopelessness, no sleep, and death. Needless to say, I’ve been looking forward to this for the past year. Oh yeah, and for those of you out there celebrating on New Year’s Eve…think of me toiling away in the Unit while you are sipping on the bubbly, and try and make your alcohol poisoning not to severe that you wind up paying me a visit in the MICU. Anyways, if my blogging productions suffers over the next month, you know the reason…

Excellent book to recommend for the inner science geek in all of us. “The Common Thread” by John Sulston, who won the Nobel Prize in 2002--he won it for work on cell death in C. elegans (a nematode worm) but the book was more about his essential role in sequencing the human genome. Prior to reading the book, I was dimly aware of the "Race for the Human Genome" between the publicly-funded Human Genome Project (of which John Sulston was a part) and Craig Venter's private corporation, Celera. Reading the book is an outstanding behind-the-scenes version (admittedly, from John Sulston's viewpoint) of the politics behind it all. To distill things into a simplistic explanation of the situation: the public project was responsible for developing nearly all of the difficult technology (e.g., the sequencing, computer analysis, organizational strategy, raw biological material with which to work) and had a committment to sharing data with the public as it became available on a daily basis. The private group got involved once the public consortium had developed the necessary technology and claimed that they would be able to do things "better", a strategy which was aimed at destroying the public group in a bid for Celera to patent as much of the human genome as possible and make some serious moolah. It's scary to think that this could have happened, but fortunately due to the uncompromising stance that Sulston and others took, the Human Genome is now completed and fully available to ALL scientists, regardless of which country or how much funding they have.

Also on the plus side, it looks like my nephew Henry is getting cuter every day!

Confirmation That The Rain Forest Is, Well, Rainy

I just got back a few hours ago from my winter funfest in the Pacific Northwest, in which I managed to pack in a good amount of activities both adventuresome and relaxing. In keeping with its reputation, it was raining every single day that I visited...

The Aventuresome: Jason picked me up at Sea-Tac Airport (which I just learned is called as such due to a hybridization of the names of Seattle & Tacoma) and I was immediately whisked away to take some short hikes in the foothills of the Cascade Mountains. Our destinations included the lovely Twin Falls & Snoqualmie Falls, the latter of which is prominently featured (along with, incidentally, psychedelic midgets speaking backwards) in the famous Twin Peaks TV series of the early 90's.

Since I had always wanted to see the Rain Forest in the Pacific Northwest, the next morning we hopped in Jason's Subaru and drove all the way out to the Olympic Peninsula to explore Olympic National Park. This also involved taking the Edmonds-Kingston ferry which enabled me to chow down on some tasty clam chowder aboard the "Walla Walla."

After our maritime excursion, we made our way out to the farthest northwest point in the contiguous United States, Cape Flattery, near Neah Bay (see map below). Not deterred by the pouring rain, we nonetheless hiked the trail and were able to watch several sea lions playing along the coastline. Our following destination was the Hoh Rain Forest, on the western edge of the main part of the Olympic National Park. We busted out the tent and managed to stay reasonably dry overnight despite a constant downpour (imagine that...rain in the rain forest!).

The next morning we hiked all about the Hoh Rain Forest and I was amazed to see the magnificent spruces, Douglas firs, and moss-caked foliage. It's really unlike anything else I've seen in my life. We also managed to see an abundance of chum salmon returning to spawn.

Other highlights of the trip: singing Christmas carols with the Medeiros family, hanging out with fellow Duluthian Chad Lukkarila & his wife Kris, and devouring a damn fine Christmas turkey with all the fixins.

Thanks, Jason!

Wayne's World?

According to a recent article in UK's "The Guardian", (and also the subject of a recent "Gia's Blog" posting, a recent poll of British children less than 10 asked the question, "Who is the most famous person in the world?" The results were somewhat surprising, and are shown below:

#1: God
#2: Wayne Rooney
#3: Jesus
#4: David Beckham
#5: The Queen

Gia's blog was most surprised based on the fact that "God" came in first.
What was surprising to me, however, was Wayne Rooney coming in second. I mean, I had to "google" him to learn who the hell he was! Turns out he is an incredibly popular 18-year old Liverpudlian soccer phenom playing for Manchester United. I've never heard of the guy, and I consider myself a sports fan. Shows how culturally different the United States and England are, I guess.

Who do you think would win this contest amongst American 10-year-olds? Lindsay Lohan? Jessica Simpson? Fran Drescher? Somebody from Nascar Nation? I think I would be scared to find out...

In more patriotic sporting news, can you believe that Johnny "of Nazareth" Damon has betrayed the Red Sox nation and is now a Yankee?! In the immortal words of the Kinks, "it's a mixed up, muddled up, shook up world." I wonder if now he will shave off his Jesus beard? (It's traditional for the NY Yankees to be a wholesome, clean-shaven bunch).

Also check out this hilarious bunch of random Chuck Norris jokes on the perfectduluthday blog.

it's madness i tell you....just madness!

T-minus two days to Christmas vacation. It definitely helps keeping this in mind while reflecting on today's craziness as the superstar Super SAR. We've got patients with brain tumors being admitted to Medicine with neutropenic fever! We've got patients with cocaine cardiomyopathy and ejection fractions of 5% being started on milrinone drips in the ER! We've got patients moving in and out of the MICU like it's a revoling door! A few minutes ago one of the other residents ran in here and grabbed the stethoscope from around me, ran out, and came back in 15 minutes later to give it to me (my Super SAR phone was ringing and I was too busy to talk to them). It's a madhouse I tell ya.

By the way, what do you think is going on in this picture? It looks like some bizarre chocolate sauce body art competition.

Only another 20 minutes and I get to bike home in the freezing home and treat myself to some extra yummy leftover barbecue bratwursts.

Stupid Topics of the Day

Stupid Topics of the Day:

1. Seattle-Bound. I'm heading out to Seattle for my short-but-sweet XMas Vacation. I've never been there before but have no doubt that my friend Jason will give me an outstanding tour.

2. Day-Time Super SAR. The only thing standing between myself and the lovely Seattle trip is three days of serving as the Day-Time Super SAR, the chief admitting resident for the hospital. Even moreso than the Night-time Super SAR rotation on which I've already rotated, the Day-Time Super SAR position is really an administrative one. I can tell you, for instance, that precisely 24 patients requiring floor or intensive care Medicine beds have occurred from the span of 8am until 4:26 pm today, and that it's a busier day than usual for the Oncology service.

3. Crappy Football Weekend. What a depressing weekend for me. First, my Fantasy Football team plays like poop and I get knocked out of the playoffs...had I won this game I would have been ensured of winning at least $70. Second, I had to watch the Minnesota Vikings suffer a humiliating loss in the presence of my friends Aravind & Sameer, two die-hard Steelers fans. Third, the Indianapolis Colts (one of my "adopted teams" given the fact that my parents live in Indy) were stopped short in their attempt to become the 2nd team ever to go undefeated throughout the course of a full NFL season.

4. Forced Feeding of Prisoners at Guantanamo Bay. During my down time today I read an interesting editorial in the New England Journal of Medicine on the prisoners of Guantanamo Bay, many of whom have decided to protest their situation by a mass hunger strike. Interestingly, the military and its physicians have taken the position that they are not going to allow the detainees to do this, and have begun a program of forced feeding. This involves the insertion of a nasogastric tube (or "NG tube") down the nose and into the stomach so that liquid food can be delivered which prevents them from starving to death. This understandably raises a host of ethical issues which are not easily answered.

5. Knights of the Old Republic: For all those of you who were wondering, the Rancor is easily disposed of by tricking it into eating a frag grenade by hiding it in the nearby corpse pile along with the artificial odor. Kaboom!

6. It's friggin' cold outside. Just thought I'd mention it. By the way, that didn't stop me from going for a pleasant run last night with naught but shorts and a long-sleeved T-shirt :) Also, did you know that -40 degrees centigrade is the same as -40 degrees Fahrenheit?

Knights of the Old Republic

So my buddy Dave bought me the Star Wars video game "Star Wars: Knights of the Old Republic" for my birthday recently. I have to say that after only a couple of hours the past two days I am indeed hooked. It's one of the role player deals where you can choose to be either a jedi or to follow the Dark Side and become a Sith. So far I've decided to tread the way of the Light. Now if I can only just figure out how to make it past the Rancor without dying...

Note to self: try not to spend TOO much of your free time on this video game...

In other news...I saw Peter Jackson's KING KONG yesterday. Long movie. A pretty good one, too. A few of the scenes on the island where a little bit random and fall into the common trap of having too many crazy things happen one right after the other (e.g. crazy lost tribe attacks, followed by the stampeding dinosaurs, followed by the giant ape, followed by the giant flesh-devouring insects, followed by the vampire bats...well, you get the picture)...but these were all in the original Kong movie and therefore I can see why they had to be included in this version. And on the plus side, the scenes with King Kong rampaging through 1930's NYC were outstanding, the big monkey boy had a definite personality, and my friends all agreed that the leading lady (Naomi Watts) was a total hottie.
Not too much work on jeopardy this week (knock on wood)...I was called in on Friday to work in the MICU (medical intensive care unit), my least favorite place in the entire hospital other than the cafeteria...but it was only for the day, none of the patients I was covering was actively trying to die, and therefore the experience could be classified as a tolerable one. Let's keep the pager silent for the rest of the weekend so I can watch the Vikings put the hurt down on the Steelers this afternoon!

Food is good.

Some photos from last night's resident dinner, which was a lot of fun. Those are my buds Matt Ortman (sporting his ever-impressive Jew-fro) and Jamal Misleh along with myself in the first picture.

The Nate Update

Congratulations to me! It's the last night of the Super SAR Nights Beat-Down Week.

It's been kind of a crazy week what with all the stuff on my plate recently. Since it's been awhile since I've blogged and there seems to be a lull in the action at the hospital for the moment, I shall break things down by topic:

1. Tonight's Eagles-Giants Football Game: I correctly predicted two months ago when my main man Dave Portnoy informed me that his girlfriend Lisa had won a pair of tickets to see the Iggles face off against the G-Men that she would decide she didn't want to go because (a) she dislikes football and (b) she dislikes sitting outside for 4 hours in the cold. Fortunately for me, I was correct, and due to my Nostradamus-like prediction I was awarded the second ticket. What a game! In my opinion, the Eagles are to be commended for nearly pulling off the upset with a bunch of second-stringers in the major skills positions. Plus I got to bust out my long underwear, which I probably haven't worn since my glory days back in Minnesota.

2. My 2nd career in Hollywood: Filming continues for our Internal Medicine holiday party, and I'm extremely excited to have the results revealed to the entirety of our residency class coming up this Wednesday! Check out our preliminary work at the website: http://www.petegabriel.com/movies/OSH.wmv

3. Diagnosing this dude with a pulmonary embolism in the middle of the night: the highlight of my week. The resident on the Orthopedics Service called me on the Med Consult pager asking him to see this young guy who was post-op from a femur fracture and was having shortness of breath and an increased oxygen requirement. Dude had an S1Q3T3 on his EKG and I holla'ed out: "Yo! You gots to heparine this beezatch for a P.E.!" My suspicions were of course verified by the V/Q scan performed in the middle of night which read "high probability for a pulmonary embolism."

4. My friend Becca's hot new blog: you can check it out at www.ludicrouslutefisk.blogspot.com. There's only one entry thus far but I have no doubt that it will set the standard for blogs everywhere. It's da bomb.

5. Christmas plans in the Pacific Northwest: I wasn't sure what I was doing until a few days ago, but recently bought tickets to celebrate the Yuletide season with my college buddy Jason Medeiros who is chillin' in the Seattle area. I was going to go to France with my wife, but I don't really have enough days off (or enough cash-money) to make it happen. I've never been to this area of the country and am excited to see what it's like.

6. Christmas cards: copies of Nate's 9th Anniversary XMas Cards are printed out and ready to be mailed out...probably will be finished in the next 7-10 days.

That's all the Nate news for now! Stay tuned to this blog for all of your 24-hour-a-day Nate Hellman News Update needs...

The Birthday Beat-Down

In case you've beeen wondering why I haven't been updating my blog as much, it's because I've been suffering the world-class beat-down that comes with being the Night-time Super SAR. The screwing with your sleep-wake cycle, the loneliness of working in the hospital after everybody has gone to bed, the seemingly endless supply of sick patients (not to mention the not-sick patients) admitted by the ER...it's all good! What a way to celebrate my 32nd birthday in style!!!

Bizarre Medical Images

It's back to work again...this week it's back to being the "Night-time Super SAR" (basically the chief admitting resident--I deal with the administrative details of assigning patients to the appropriate team, plus I get to treat the patients who are admitted through the ER late-night), working shifts from 8pm-8am (and, incidentally, marks the 3rd consecutive year that I have been either working or post-call on my birthday, which is coming up on Dec. 8th).

For tonight's blog entry I give you two bizarre medical images...both of which have been admittedly pilfered from the New England Journal of Medicine "Medical Mysteries" section.

The first image is a 10-year-old boy with a brown eye on the right and a blue eye on the left. What's the deal, you might ask? Turns out there is a very mild ptosis (drooping) and more noticeable miosis (the pupil is a little smaller) in the left eye compared to the right eye. It can result from compression of the sympathetic nervous system on the right side and causes an entity known as Horner's Syndrome. In children, the sympathetic nervous system also stimulates the synthesis of melanin, the pigment which makes up the iris. This kid unfortunately had a left-sided paravertebral neuroblastoma (a type of tumor).

The next image is far more gruesome in appearance, but demonstrates some badly disfigured hands. The answer to this "Medical Mystery" has not yet been revealed so I'll just have to guess. I'm going to go with "chronic tophaceous gout", because you can see a ton of nodules scattered about. Other possibilities would include severe rheumatoid arthritis or lepromatous leprosy.

Annoying Celebrities

It's been a very "creative weekend" for me...my pager's been eerily silent & another few hours I'll have completed my week of jeopardy with only two hits. Was at my friend Pete's for over eight hours taping footage for our video which I think is going to rock the house. Today we went into the hospital and did more of the same.

In terms of the Xmas card, I made some heady this morning…there’s just so much material regarding annoying celebrities, I don’t know where to start.

XMas Card Sneak Preview!

Our sources within Hellman Productions Ltd have discovered this leak of what the famous (or perhaps infamous is the better descriptor) annual Nate Hellman Christmas Card will be like this year in 2005. Rumors have surfaced which suggest a "celebrity tabloid" theme featuring the wedding of Hellman and his starlet wife Claire Pecqueur.

A representative of Hellman Productions Ltd has declined to comment on the veracity of these rumors and has stated that any leaks within the organization will be aggressively sought out and tortured hideously.

Stay tuned for further updates!

A Tour of Philly's Least Desirable

Chateaubriand grant: pretty much done :)

Jeopardy : I've been called in twice so far. Overall the assignments have been fairly easy (only about 4-5 hours each) so I suppose not a lot to complain about.

After resident report today my friend Pete Gabriel went for a tour of the least scenic areas of Philadelphia, cruisin' the streets in his 64. The goal? To collect video footage for our Holiday XMas Skit, an annual tradition in our Department of Medicine where residents throw together some brief skits which make fun of our attendings, the hospital, and most of all ourselves. The gag this year is making use of the fact that Pete was really hired to do a "recruitment video" to show to prospective applicants--it turned out great. For the XMas Skit we are going to make an "anti-recruitment video" which shows all the crappy areas of Philadelphia and all the shitty aspects of our job (neither of which, in all honesty, should be all that difficult).

Anyways, our little field trip was pretty memorable. Highlights included a visit to the Philadelphia Oil Refinery (photo below), collecting multiple photo shots of a variety of fried chicken joints in the hood, having Pete's car assaulted by a gang of uppity teens on Broad Street, and talking to this one dude who asked specifically not to be filmed because, "I've got warrants out, Pimp Daddy!"

Should be interesting to see what turns out from all of this...

No more monkey business

Crap can you believe it's already December?

It's time for me to cut out the monkey business from my life and get some serious work done. The grant deadlines are getting closer and I need to make good use of all this sweet free time I've been getting since I haven't been getting called on jeopardy. Today's goal (assuming I don't get called in to work): finish my Chateaubriand grant and get started on a FRM grant.

I also have a meeting with my friends Kara and Jon tonight to plan our trip to Botswana, Africa. We're all going there as part of a 6-week hospital rotation which should be quite the experience.